Pharmacology Flashcards
What is the role of OT in medication management?
Understand the consequences and implications of common medications
Assist patients in ordering and refilling-patterns
Fine motor skills-handling pill, filling pill containers
Strength: opening containers
Cognition: taking at the right time, the correct amount, recognizing side effects
__ and __ can affect the pharmacokinetics of a drug.
exercise and application of PAMS and therapy
Therapy interventions seem to have the greatest potential to affect ___ of drugs that are administered by trans dermal techniques or by subcutaneous and intramuscular injection.
absorption and distribution
What is a drug?
any nonfood chemical that impacts the mind or body
What is pharmacology?
the study of medicines or drugs and their effect on the body
What is medicine?
something that is deliberately administered to prevent, diagnosis or have a therapeutic impact
Medical uses for drugs
Prevent Illness or Disease
- Prophylaxis
> Motion sickness
> Contraceptive
> Vaccinations
Diagnostic Use
- Contrast dyes
- Drugs that mimic exercise
Therapeutic Use
- Antibiotics
- Analgesics
- Management of diabetes, thryroid, cardiac
Who can prescribe medications?
Medical doctors
Osteopathic doctors
Dentists
Podiatrists
Chiropractors
Psychologists
Optometrists
Military PT
Physician assistants
Nurse practitioners
What is the FDA’s job regarding medications?
To make sure that it is
- pure
- effective
- balance between value and risk
Responsible for the review and approval of all new drugs before they can be made available to the public
When did laws start to pass to protect consumers from drugs?
1900s
What laws were created in the 1900s to protect consumers from drugs?
Food Drug and Cosmetic Act 1938: drug manufacture had to show it was safe
Durham-Humphrey Amendment (1951): prescription drugs could only be given with physician supervision
Kefauver-Harris Amendment (1962): drugs had to be safe and effective
1990s: tamper proof packaging
First and prior to applying for drug approval, the manufacturer must do…
preclinical testing
- may take 3-6 years
- involves lab and animal testing to determine biological activity of the drug
What are types of non-adherence?
Taking someone else’s meds
Taking more or less
Skipping doses
- Financial reasons
- Physical reasons
> Cant open
- Cognitive reasons
> Forgets
> Decides not to take due to evening out
Failure to follow directions
- Take with food
Stopping without consulting doc
Not filling meds
Health system related ways an OT can impact medication management?
Difficulty getting in with doc to renew prescription
Drug restrictions (dosage amounts, requirements)
Condition related ways an OT can impact medication management?
Asymptomatic chronic disease
- High Blood Pressure
Mental health related
- “I don’t need it”
Patient related factors an OT can impact medication management?
Pt impairments-physical or psychological
Behavioral
- Denial, anger
Therapy related ways an OT can impact medication management?
Complex medicine regimen
Incompatible with lifestyle
Side effects
Social stigma
Social and economic related ways an OT can impact medication management?
Cost
Lack of insurance
Language barrier
Cultural beliefs and attitudes
Poor social support
Health care literacy
- Cranberry juice is just as good as antibiotics
What is polypharmacy?
Typically 5 or more medications
30% of those over 65
In the US $1000.00 per person each year
Europe-$300.00
What are issues with polypharmacy?
- Increased risk of medication related issues-interactions
- Correct dosage, time of day, number of pills etc
- Economic burden
Why does OT care about polypharmacy?
Impact to therapy outcomes (LBP-intervention vs meds)
Impact to functional status
- Positive and negative
- 5 MMT, Full AROM, no energy-doesn’t do anything
- No pain, increased function (PT, OT or meds??)
- Change in status (new med on board??)
Adverse Reactions
- Side effects
- Fall risk
- Change in cognition, balance, motor function
What is pharmacodynamics?
The study of the action of the drug on the body
This includes the biomechanical and physiologic effects of the drug as well as the mechanism of action at the target cell or organ
- adverse side effects are a form of negative pharmacodynamics
- includes how the drug works
What is pharmacokinetics?
The study of how the body deals with the drug, including absorption, distribution, metabolism, and excretion
- how long required for the action, how long will it last, what factors speed up or slow down the effect
Is polypharmacy in our scope of practice?
advocacy, ADLs, in their homes
How does aging impact absorption (drug getting into system)?
May be slowed but the absorbed share is most often not effected
Change is due to decreased function of ventricles, intestines, and blood flow to intestines
Of little importance
How does aging impact distribution?
Decreased hydrophilic drug distribution, increase lipophilic drug distribution
Change is due do decline in fat-free mass and increase in body fat with aging
Important for some drugs
Drugs that may be affected: diazepam, digoxin, lithium
How does aging impact metabolism?
Hepatic metabolism may be reduced
Change is due to decreased hepatic blood flow and liver mass
Important for several drugs
How does aging impact renal elimination?
Renal elimination is reduced
Change is due to decreased glomerular filtration rate
Very important
What is medication reconciliation?
July 2004 – Joint Commission announces 2005 national patient safety goal #8 – medication reconciliation required for all accredited systems
8a)Implement a process for obtaining and documenting a complete list of the patient’s current medications upon the patient’s admission to the organization and with the involvement of the patient. This process includes a comparison of the medications the organization provides to those on the list.
8b)A complete list of the patient’s medications is communicated to the next provider of service when a patient is referred or transferred to another setting, service, practitioner or level of care within or outside the organization.
Joint Commission recommendations on medications
Placing the medication list in a highly visible location in the patient’s chart and including dosage, drug schedules, immunizations, and allergies or drug intolerances on the list.
Creating a process for reconciling medications at all interfaces of care (admission, transfer, discharge) and determining reasonable time frames for reconciling medications. Patients, and responsible physicians, nurses and pharmacists should be involved in the medication reconciliation process.
On discharge from the facility, in addition to communicating an updated list to the next provider of care, provide the patient with the complete list of medications* that he or she will be taking after discharge from the facility, as well as instructions on how and how long to continue taking any newly prescribed medications. Encourage the patient to carry the list with him or her and to share the list with any providers of care, including primary care and specialist physicians, nurses, pharmacists and other caregivers.
What is the chemical name of a drug?
Specific compound structure, long and cumbersome name, non-proprietary, chemical structure of the drug
methylpropyl (phenyl), propanoic acid (Ibuprofen)
What is the generic name of a drug?
Official or nonproprietary and derived from the chemical name
The more consistent name, single name for a drug: e.g. Ibuprofen—usually less expensive
What is the trade name of a drug?
Brand name assigned by and OWNED by the pharmaceutical company, proprietary
Several companies may market the same generic drug under different names: Advil, Motrin, Mepipren
What is the difference between the generic and trade name?
Generic:
- Less expensive
- Safe and effective provided within the specific range criteria through testing on active ingredients (bioequivalent)
- “Off label”
- May still experience different affects than with the brand name drug
Trade (brand):
- More expensive
- Very specific effect for given conditions
- Preferred for those drugs that have a wider range of therapeutic and adverse effects when tested
Trade name of pseudophedrine
actifed, sudafed
Trade name of erythromycin
e-mycin, erythrocin
Trade name of cephalosporin
Keflex, Keflin, Suprax, Utrace
Trade name for penicillin
V-Cillin, Amoxil
Trade name for acetaminophen
TylenolT
Trade name for naproxen sodium
alieve
Trade name for ibuprofen
motrin, advil
Why are generic drugs cheaper than brand-name drugs?
A large portion of the cost of brand name drugs covers the high cost of research and development
Generic manufacturers do not have to duplicate the cost of research and marketing conducted by the original manufacturer
Therefore, the cost of the generic drug is usually less
Standard practice and most state laws require that a generic drug be generically equivalent to its brand-name counterpart.
Same active ingredients, strength, and dosage form—pill, liquid, or injection
Must be therapeutically equivalent—it must be the same chemically and have the same medical effect
Advantages of generic vs. brand-name drugs
Generic drug usually marketed under generic name, which usually indicates the active ingredients
Brand-name does not indicate active ingredients
FDA approves of nonprescription drugs if…
they are safe when the directions are followed
To become an OTC drug…
The use must be similar to the use when it was a prescriptions
Pt can easily monitor and diagnosis self without medical knowledge
There is a low rate of side effects
No monitoring or additional test required
Schedule I drugs
Ex: marijuana, LSD, ecstasy (MDMA), heroin
Highest potential for abuse and no accepted medical use and are not safe under medical supervision
Schedule II drugs
Ex: cocaine, opium, high grade morphine, oxycodone, methamphetamines (adderall)
High potential for abuse, despite having an accepted medicinal use in the US
Schedule III drugs
Ex: low grade morphine, anabolic steroids, ketamine, certain codeine mixtures
Can lead to moderate physical dependence or high psychological dependence
Schedule IV drugs
Ex: ambien, valium, xanax, rohypnol, zolpidem, soma, darvon, darvocet, ativan, talwin
Has accepted medical use in the USE, but abuse of the drug may lead to limited physical or psychological dependence
Schedule V drugs
Ex: cough syrup, lomotil, motofen, lyrica, parepectolin
Substances with limited quantities of certain narcotics that have less potential for abuse and have accepted medical use in the US with limited risk of physical/psychological dependency
Non prescription OTC drugs
Low frequency of toxic or adverse effects
No need for periodic blood work or medical evaluation
Effective with significant portion of patients
Usually contains less drug per dose when compared to the corresponding prescription drug
- Alieve (200 mg tablet) - OTC
- Naproxen (250 or 500 mg tablet) prescription/OTC
Prescription drugs
Greater potential for adverse effects
Monitoring needed for interactions
Restricted for period of time for use
Classified into schedules of drug
- Schedule I: controlled substances, highest abuse potential
- Schedule V: lowest abuse potential
- Schedule III: includes anabolic steroids
What do you think of medical marijuana?
gonna be a discussion question
Symptoms for vitamin D toxicity
cramps, nausea, vomiting, calcium, crystal deposits that affect liver, kidney, lungs (calcium salts are irreversible)
Symptoms for vitamin A toxicity
water in the brain, vomiting, tiredness, constipation, bone pain, brittle nails, hair loss, birth defects
Symptoms for vitamin B6 toxicity
mobility issues such as tingling and numbness in hands and feet, trouble walking, trouble grasping small objects (difficult to reverse symptoms)
Symptoms of vitamin C toxicity
kidney and gallbladder stones in those prone, but normally it just makes really expensive urine
Symptoms for folate toxicity
pernicious anemia, kidney damage
Symptoms for vitamin B12 toxicity
diarrhea, swelling, blood clots in legs
Symptoms for vitamin K toxicity
anemia in adults, death in infants
Symptoms for niacin toxicity
flushed skin, nausea, diarrhea, liver damage
Symptoms of vitamin E toxicity
headache, tiredness, double vision, diarrhea, vitamin A, D, K deficiency
What is an agonist drug?
What is an antagonist drug?
a drug that binds to a protein but doesn’t activate
What is a side effect?
Any effect other than the therapeutic effect desired
Sometimes the side effect can become a therapeutic effect, like Botox
What are adverse effects (AE)?
Severe side effects-often don’t know till there a lots of people and several years
May result in a drug being pulled
Black box warning - life altering/threatening effects
What is a toxic effect?
Happens over time
Dosage is above the therapeutic level
Therapeutic Index (remember we want a large index!)
Some drugs have a narrow margin
- These pt’s have to be monitored more closely for toxicity
- Lanoxin, Accutane, Lipitor(kidney and liver failure)
What is a paradoxical effect?
Opposite effect in certain patients
Amphetamines (given to ADHD kids)
Symptoms of an allergic reaction
Mild to severe-itching to death
Anaphylactic shock
What are idiosyncratic reactions?
Reaction to a drug that is different than expected due to a specific genetic make up, usually a specific ethnic group: Asian, Jewish, African etc.
What is malignant hyperthermia?
uncontrolled body temp after a a dose of succinylcholine-can be deadly
What is synergism?
Two drugs create a stronger effect
- Tylenol and Codeine
What is antagonism?
Two drugs create a weaker effect than either would on it’s own
- Antibiotics and Birth control
What is a drug food interaction?
happens when the food you ear affects the ingredients in a medicine you are taking so the medicine cannot work the way it should
Most common medications associated with adverse drug effects in the elderly
opioid analgesics
NSAIDs
anticholinergics
benzodiazepines
cardiovascular agents
CNS agents
musculoskeletal agents
Describe medication labeling
Overly technical
Print too small
Too much information
No standardization
Issues of literacy
How to simplify labels for pts
Highlighting of basic information
One nugget of information per line
Basic language easily understood
Losartan potassium
Generic name: Losartan Postassium
Brand name: Cozaar
Used to treat hypertension
Can also be used to help protect the kidneys from damage due to diabetes.
Alendronate
Generic: Alendronate
Brand name is Fosamax and Binosto
Prevent osteoporosis
Side effect: nausea, heart burn
Never take alendronate at bedtime it will not fully absorb in the system.
Digoxin
Generic: Digoxin
Brand name: Lanoxin
Used to control the rate and rhythm of a pt heartbeat.
Reduces swelling of hands and ankles in pts with heart problems
Should avoid taking OTC antacids
This is also used to treat angina (heart pain) and may be used after a heart attack
Tylenol
Generic name: Acetaminophen
Brand name: Tylenol
Mild-moderate pain reliever
Should be avoided if you have liver disease
Can be taken to reduce fever.
Can cause instant renal failure after having consumed alcohol within 72 hours
Warfarin
Generic name: Warfarin
Brand name: Coumadin, Jantoven
Helps prevent blood clots from forming.
Aspirin and warfarin are two commonly prescribed blood thinners they should not be taking together due to increase bleeding.
Vitamin K is the antidote for warfarin.
Can not take Warfarin before surgery due to risk of increased blood loss during surgery
Lasix
Generic: Furosemide
Brand: Lasix
Treats fluid retention
Used for pts with congestive heart failure, liver disease, or a kidney disorder
This medication can make your skin sensitive to sunlight; protective clothing, sunglasses, and sunscreen are highly recommended when taking this medication
Can be injected instead of in a pill
Thyroxine
Generic name: Levothyroxine
Brand names include: Synthroid, Unithyroid, and Levoxyl
Can also treat thyroid cancer and enlarged thyroid
Used to treat hypothyroidism, an under active thyroid
Nitroglycerin
Generic: Nitroglycerin
Brand Name: Nitrostat
Prevents and treats chest pain
Lowers blood pressure as well.
When used rectally, it can treat pain caused by tears in the skin around the opening for bowel movements (anal fissures).
This medication allows more blood to flow to the heart
Metformin
Generic name: Metformin
Brand Name: Glumetza
Helps to restore the body’s response to insulin, used for type 2 diabetes
Can be used to treat PCOS
Esomeprazole
Generic name: Esomeprazole
Brand name: Nexium
Used to treat indigestion, heartburn, and acid reflux
Patients taking PPIs have a higher risk of developing kidney disease
NSAID
Generic (brand) name: Aspirin (excedrine), Ibuprofen (advil, motrin), Naproxen (aleve, midol)
Relieves pain, reduces inflammation, reduces fever
Chronic use of NSAIDs may also present higher risks for people with heart disease, high BP, or diabetes
Chronic use can lead to anemia
Avoid taking NSAIDS if you have: kidney disease, liver disease, heart failure, history of stroke or heart attack, HBP if it’s difficult to manage
Levodopa
Generic name: levodopa
Brand name: Sinemet
Used for Parkinson’s
